To the Editor: The review of antidepressants for bipolar depression by Dr. Gijsman et al. provided an excellent overview of the randomized, controlled trials in the literature. However, the presented data all reflect acute antidepressant treatment response, with the longest study duration (10 weeks). Bipolar disorder is a chronic, relapsing condition, with an etiology likely distinct from that of unipolar depressive disorder, for which current antidepressants were specifically developed. Treatment approaches applied to alleviate symptoms during acute exacerbations may have significant impact on the long-term course of the illness. The authors did not present evidence that the long-term outcomes are favorable with antidepressant treatment; thus, their conclusion to challenge the APA practice guideline for recommending lithium or lamotrigine as first-line treatment for bipolar depression is unfounded.